A Retrospective Study of 518 Kidney Transplant Recipients to Evaluate the Association of Antiplatelet Therapy With Long-Term Cardiovascular Events and All-Cause Mortality.

BACKGROUND We investigated the association of single antiplatelet (AP) therapy with reduction of cardiovascular disease (CVD) events in kidney transplantation recipients (KTRs). MATERIAL AND METHODS This retrospective single-center study included KTRs from our institution between 2015 and 2024. Patients receiving anticoagulation or dual AP therapy were excluded. Patients were divided into those receiving AP therapy after kidney transplantation (AP group) and those not receiving such therapy (NoAP group). A separate analysis was performed for patients without known CVD. The primary outcome was a composite of all-cause mortality and major adverse cardiovascular events (MACE). Major bleeding events were also recorded. Kaplan-Meier survival curves and Cox proportional hazards models were constructed. RESULTS Overall, 518 KTRs met the study criteria (175 AP, 343 NoAP). The AP group was significantly older and had higher prevalences of diabetes and coronary artery disease. Over a median follow-up of 52.5 months (interquartile range: 33.1-71.1), 41 (24%) patients in the AP group and 76 (22%) patients in the NoAP group experienced the composite study outcome. After adjustment for confounders, AP therapy was independently associated with a lower risk of the outcome (hazard ratio 0.67, 95% confidence interval 0.45-0.99, P=0.046). AP therapy was not associated with major bleeding events. No significant association between AP therapy and outcomes was observed among patients without known CVD. CONCLUSIONS AP therapy after kidney transplantation was associated with lower risk of the composite outcome (MACE and all-cause mortality) in the overall cohort. No significant association was observed among patients without known CVD.